Therapeutic Adherence in Cardiovascular Diseases: Insights from the Patient and Physician—A Narrative Review

Therapeutic adherence is defined as the extent to which patients’ medication-taking behaviour corresponds with agreed recommendations from a clinician. Adherence to cardiovascular therapies significantly improves outcomes and improves patient quality of life. However, adherence is often suboptimal in patients with cardiovascular disease. This narrative review aims to describe key barriers to adherence and identify practical actions that can be undertaken by all stakeholders to improve treatment adherence. Key barriers fall into categories related to the patient, medication, healthcare system, disease and society. These include, but are not limited to, logistical challenges faced by patients incorporating medication into their daily lives, fragmented care, the patient-physician relationship, the complexity of the regimen and medication costs. While macro-initiatives to remove health system and societal barriers are encouraged, there are many practical ways in which patients can also be supported to adhere to medication. These include improving communication techniques to build a trusting physician-patient relationship, engaging other healthcare professionals (e.g. nurses and pharmacists), referral to patient advocacy groups for reliable information and peer support, simplifying treatment regimens where safe and appropriate, the use of digital tools or devices (e.g. pill boxes and symptom trackers) that help patients to take their medication in the right dose and at the right time and consideration of the patient’s budgetary constraints when prescribing. Prescribing formulations for once-daily administration and single-pill combinations can also help to simplify treatment regimens. No single solution will fit all patients, and initiatives to enhance adherence must also be tailored wherever possible to the individual patient’s abilities, circumstances, values and beliefs. Therapeutic adherence refers to how well patients follow their doctors’ advice on taking their medications. People with cardiovascular disease often find it difficult to take their medication correctly, but this is important for them to benefit from treatment. There are many reasons why patients might struggle to take their medications correctly. Patients might find it difficult to fit their medications into their daily routine, they might have lots of other medicines to take, the cost of medicines might be too high or they might struggle to navigate the intricacies of the healthcare system. Poor communication between patients and physicians could also make it harder for patients to take their medication correctly. This review suggests strategies to overcome barriers and improve patients’ adherence to cardiovascular disease medications. A good doctor-patient relationship is essential, and other health professionals, like nurses and pharmacists, can also help to support patients. Patients may also find it useful to join a support group that can give them reliable information and connect them with other individuals facing similar challenges. Having fewer pills to take and needing to take them less often can also help, such as when two or three medicines are combined into a single pill that can be taken once daily. Digital tools, like pill organizers and symptom trackers, can further assist patients in taking their medications correctly. The best way to improve therapeutic adherence is to make sure that the tools used are chosen for each patient based on their own individual needs.